Medical video assisted thorascopic surgery (VATS) with talc pleurodesis is an effective procedure for the treatment of recurrent malignant effusions. The most common severe morbidity is adult respiratory distress syndrome (ARDS) occurring in approximately 3-9% of patients. The goal of this study was to determine the exact incidence of renal insufficiency following medical VATS with talc pleurodesis.
Retrospective review of medical VATS with talc pleurodesis performed at Georgetown University Hospital, a tertiary care center in Washington DC, from August 1995 to March 2004. We defined renal insufficiency as a doubling in baseline serum creatinine (Cr).
152 patients underwent medical VATS with talc pleurodesis using sterile asbestos-free talc (Spectrum®). The procedure was most commonly performed for breast cancer followed by lung cancer. Overall, 9 patients (7.5%) developed renal insufficiency following the procedure. Of these, 4 (45%) fully recovered renal function, 3 (33%) remained with some renal impairment (defined as a serum Cr >1.5 in males and serum Cr > 1.2 in females) and 2 (22%) developed renal failure. Both these patients elected not to pursue hemodialysis and died from advanced malignancy. In 89% of the renal insufficiency cases, fractional excretion of urine sodium was less than 1%. No patients developed reexpansion pulmonary edema.
Talc pleurodesis via medical VATS can be associated with renal insufficiency. The mechanism of injury remains unclear but may be secondary to fluid management practice of keeping these patients dry. The safest talc particle size and amount are still to be determined.
There may be a role for perioperative fluid administration to patients undergoing medical VATS with talc pleurodesis to avoid renal insufficiency.
C.A. Reichner, None.